Decoding Itch in CKD: From CKD-aP Suspicion to Solution

Quantifying CKD-aP: Tools for Better Care 

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Dr. Burton:
This is CME on ReachMD, and my name's Dr. Jim Burton. It's lovely to see everyone. Here with me today is my colleague Dr. Emilio Sánchez. And Emilio, today we're talking about the assessment of severity and impact of CKD-associated pruritus.

So, Emilio, tell me, what tools have we got for assessing CKD-associated pruritus in patients on hemodialysis, and how should healthcare providers and healthcare professionals be using those in our everyday practice?

Dr. Sánchez:
Thank you for this interesting question. And I want to begin saying that to aid the diagnosis of CKD-aP, there are several scales commonly used in practice. One of the most commonly used is the WI-NRS, the Worst Itch Numerical Rating Scale, a one-dimensional scale that asks the patient about the rating of their worst itch, which can range from no itch, which it means 0 points, to the worst itch imaginable, which is 10 points. Scores are categorized in 4 strata: no pruritus, mild, moderate, and severe. And we know that changes in 3 or more points are clinically significant.

In another way, traditionally, this scale uses question 20 in the SF-36 quality of life questionnaire. With only one single question, we have an idea of the impact of pruritus in the last month, and it is widely used and validated for CKD population. This scale is also unidimensional and asks how much the patient has been bothered by itching in the last 4 weeks, and the responses range from not at all to extremely bothersome.

There are also multidimensional models that not only assess the intensity of itching, but also consider its impact on quality of life. The SADS, which is the acronym of Self-Assessed Disease Severity of illness scale, due to its simplicity is one of the most widely used and distributes patient responses into 3 levels of affectation, with score A being the mildest and C the most severe.

The Skindex-10 is another multidimensional model which asks 10 questions and is scored from 1 to 6. It analyzes 3 spheres: the disease itself, the emotional impact, and finally, the social impact.

And finally, the 5-D itch scale specifically diagnoses for CKD-aP and is sometimes used to analyze the evolution of itch over time. It has 5 questions answered with a score ranging from 1 to 5.

And these are the most used tools to diagnose and to manage CKD-aP.

Dr. Burton:
There are a number of different tools, but I guess one of the most important points is to use one of those validated tools in our practice. By asking someone and getting a baseline score, we know that there are treatments and things that we can do to manage itch, and having that baseline score enables us to, I guess, kind of assess that response to treatment, because some of the newer treatments—for example, the kappa-opioid receptor agonists—we can see that for those people with a significant amount of itch—you mentioned the WI-NRS—you can see in up to 74% of people are more than 3-point, a clinically relevant improvement in itch scores from baseline. And for some people, for up to 25 of people with moderate to severe itch, there's actually a complete resolution that we can see from the data.

So I guess you would probably agree that whichever one of those we use, it's just important to get that baseline score of itch.

Dr. Sánchez:
Yeah, I think so. And it is important to proactively move with these tools.

Dr. Burton:
Well, thanks for breaking that down for us, Emilio. I think that's about our time. Thanks to the audience for listening in, and we will see you for the next episode.

Dr. Sánchez:
Thank you.

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Overview
Despite its prevalence, chronic kidney disease–associated pruritus (CKD-aP) remains underrecognized and undertreated in patients undergoing hemodialysis, owing to its complex pathophysiology, diagnostic challenges, symptom cluster etiology, and multidimensional impact on quality of life. Learn best practices from the experts, including how to use validated tools and structured approaches for assessing CKD-aP severity, and evidence-based, patient-centered treatment strategies. Using real-world case reviews, explore the value of multidisciplinary care, communication, and shared decision-making to address the physical and psychosocial complexities of CKD-aP.
Disclosure of Relevant Financial Relationships
In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Faculty:
James Burton, DM, FRCP
Professor of Renal Medicine
University Of Leicester
Leicester, United Kingdom

Dr. Burton has reported the following relevant financial relationships or relationships with ineligible companies of any amount during the past 24 months:
Consulting Fees: A. Menarini, AstraZeneca, Boehringer Ingelheim, CSL Vifor, Diaverum

Leonie Kraft, MD
Department of Internal Medicine and Nephrology
Robert-Bosch-Hospital Stuttgart
Stuttgart, Germany

Dr. Kraft has reported the following relevant financial relationships or relationships with ineligible companies of any amount during the past 24 months:
Consulting Fees: AstraZeneca, CSL Vifor

Lucio Manenti, MD, PhD
Nephrology Unit
Azienda Ospedaliero-Universitaria di Parma
Parma, Italy

Dr. Manenti has reported the following relevant financial relationships or relationships with ineligible companies of any amount during the past 24 months:
Consulting Fees: CSL Vifor

Jose Emilio Sánchez, MD, PhD
Head, Nephrology Departament
Hospital Universitario Central de Asturias
Oviedo, Spain

Dr. Sánchez has no relevant relationships to disclose.

Reviewers/Content Planners/Authors:
Cindy Davidson has no relevant relationships to disclose. 
Brian P. McDonough, MD, FAAFP, has no relevant relationships to disclose. 
Katie Sheridan, PhD, has no relevant relationships to disclose.
Learning Objectives
Upon completion of this activity, learners should be better able to:
Describe the epidemiology, pathophysiologic mechanisms, and multidimensional impact of CKD-associated pruritus (CKD-aP) in patients receiving hemodialysis
Assess CKD-aP severity and impact using validated tools, including the WI-NRS, 5D-Itch, and patient-reported outcome measures (PROMs), as part of a systematic diagnostic approach
Develop patient-centered, multidisciplinary management strategies that address physical symptoms and improve quality of life (QoL) in patients with CKD-aP
Implement strategies that address the biopsychosocial burden of CKD-aP through patient-centered communication and coordinated multidisciplinary care
Target Audience
This activity has been designed to meet the educational needs of nephrologists, nephrology advanced practice providers, dermatologists, and dermatology advanced practice providers, as well as all other physicians, physician assistants, nurse practitioners, nurses, pharmacists, and healthcare providers involved in managing patients with CKD-aP.
Accreditation and Credit Designation Statements
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team. 

Global Learning Collaborative (GLC) designates this enduring activity for a maximum of 1.0AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Learning Collaborative (GLC) designates this activity for 1.0 nursing contact hour(s). Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Global Learning Collaborative (GLC)/AXIS Medical Education designates this activity for 1.0 contact hour/0.1 CEUs of pharmacy contact hour(s).

The Universal Activity Number for this program is JA0006235-0000-25-091-H01-P. This learning activity is knowledge-based. Your CE credits will be electronically submitted to the NABP upon successful completion of the activity. Pharmacists with questions can contact NABP customer service (custserv@nabp.net). 

Global Learning Collaborative (GLC) has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit(s) for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credit(s). Approval is valid until October 24, 2026. PAs should claim only the credit commensurate with the extent of their participation in the activity.
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Our ultimate goal is to improve the care being delivered to patients, and our high-quality, evidence-based CME initiatives reflect our dedication to the creation and execution of excellence and are the product of shared research, knowledge, and clinical practice skills across the healthcare continuum.
Commercial Support
This activity is supported by an independent educational grant from CSL Vifor.
Disclaimer
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of GLC and Medtelligence. This presentation is not intended to define an exclusive course of patient management; the participant should use his/her clinical judgment, knowledge, experience, and diagnostic skills in applying or adopting for professional use any of the information provided herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Links to other sites may be provided as additional sources of information. Once you elect to access a site outside of Medtelligence you are subject to the terms and conditions of use, including copyright and licensing restriction, of that site. 

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Publication Dates
Release Date: 10/24/2025
Expiration Date: 10/24/2026